Document resource
Background Nintedanib slows pulmonary fibrosis progression and has been licensed for IPF patients since 2014. Nintedanib is now licensed for treating progressive pulmonary fibrosis of known causes, including rheumatoid arthritis, based on the Inbuild trial. Approximately 25% of patients in the Inbuild study had connective tissue-associated interstitial lung disease (ILD); however, the only immunosuppressant permitted was prednisolone. Disease-modifying antirheumatic drugs (DMARDs) are the mainstay treatment for articular and extra-articular manifestations of rheumatoid arthritis. These include conventional synthetic DMARDs such as Methotrexate and Sulfasalazine as well as biological agents such as Adalimumab and Rituximab. Here, we therefore compare real-world experiences of Nintedanib in IPF and RA-ILD patients, including patients treated with DMARD therapies.Methods We conducted a retrospective study of all patients initiated on Nintedanib for IPF (n=72) and RA-ILD (n=18) from our tertiary centre database between April 2023 and April 2024. Mean values were compared using Wilcoxon rank sum analysis and Chi-squared or Fisher’s exact test for categorical data.Results Patients with RA-ILD had more severe disease at treatment initiation compared to those with IPF; FVC (80%±4.1 vs 88%±6.9, p=0.064) and TLCO (48±6.9 vs 58±3.7, p=0.025) ( table 1). At 6 months both groups showed relative stability of FVC with changes <5% suggesting treatment efficacy. A greater proportion of RA-ILD patients discontinued Nintedanib (59% vs 36%, p=0.086), however, the total duration of treatment was longer (13.2±3.0 vs 5.0±0.97 months, p<0.001).Abstract P24 Table 1Comparison of Nintedanib outcomes in IPF vs RA-ILDConclusion RA-ILD patients tend to start Nintedanib at a later point in their disease compared to IPF, reflecting the differences in licensing. Our results support Nintedanib delaying progression of disease. We demonstrate a higher rate of treatment cessation in the RA-ILD group than was seen in the INBUILD study warranting more research to understand whether this relates to disease severity at initiation or the co-prescription of DMARDs.